Leveraging Hospital Breastfeeding Data to Improve Maternity Care

Practices and Breastfeeding Rates

National WIC AssociationSeptember 11, 2012

Karen Farley, RD, IBCLCCalifornia WIC Association

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Objectives• Describe the collaborative process using hospital

breastfeeding data to improve hospital breastfeeding policies.

• Identify 3 strategies for raising public awareness of breastfeeding hospital policies.

• Illustrate the collaborative impact of maternity care practices in hospitals and WIC.

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Mission of Project

• Bring attention to the gap in ‘any’ and ‘exclusive’ breastfeeding rates in hospitals, particularly hospitals with large populations of low-income mothers

• Produce a statewide grassroots media campaign with the breastfeeding coalitions

• Multi year strategy using many approaches to advocate for improved exclusive breastfeeding rates by urging hospitals to adopt the California Breastfeeding Model Hospital Policies or Baby Friendly designation

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•Newborn screening program of CDPH

•Epidemiologists in MCAH of CDPH

•University of CA, Davis, Human Lactation Center

•California WIC Association

•Local and State Breastfeeding Coalitions

Collaboration increased data visibility

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In-Hospital Breastfeeding Data Source:Newborn Screening Form

• Administered by the CDPH Genetic Disease Screening Program

• Data collected and placed on CDPH website since late 1990’s

• Data validated 7

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0102030405060708090

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Breastfeeding Rates

Lowest Performing HospitalsPercent Breastfeeding, 2011 Data

Any Breastfeeding Exclusive Breastfeeding

Highlighting “The Gap” Graphically

Identified the “problem” (the gap) while providing “tools” (policies) to fix the problem

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County Fact Sheets

Using the Data Locally – Any versus Exclusive Breastfeeding

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The Role of Hospital Policies• Hospitals that have

implemented “Baby Friendly” or model policies have low supplementation rates

• Research supports that “Baby Friendly” status increases exclusive breastfeeding during and after the hospital stay– Policies are intended to

be implemented as a group, not individually

Kramer, JAMA, 2001; Merewood, Pediatrics 2005; UCD Hospital Rpt, 2008 12

Referral to Evidence• CDC Guide to Breastfeeding Interventions

www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf

• Baby Friendly Hospital USAwww.babyfriendlyusa.org

• Providing Breastfeeding Support: Model Hospital Policy Recommendationswww.cdph.ca.gov/programs/BreastFeeding/Documents/MO-05ModelHospitalPolicyRecommend.pdf

• The Joint Commissionhttp://www.jointcommission.org/perinatal_care/

• The Surgeon General’s Call to Actionhttp://www.surgeongeneral.gov/library/calls/breastfeeding/index.html

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Policies Protect Staff and Patients

• Problem– Insufficient numbers of

skilled support staff (time)

– Mother’s “change their minds” or demand formula

– Individual MDs routinely supplement all infants

– Mothers and infants separated

• Policy Solution– Policy dictates staff

training/ratios

– Charting policies can help identify cause, support staff

– Policy requiring medical need for supplementation

– Rooming-in/couplet care policies

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43% of California's babies get breast milk exclusivelyAdvocates, announcing survey results today, say the total should

increase because of benefits to mothers and children.

By Mary Engel, Los Angeles Times Staff Writer, 2007

The new mother was determined to nurse her son, despite her discomfort after a Cesarean section. But a nurse, without asking, fed the infant formula while he was in the hospital nursery. That was upsetting enough, but then, when given the chance to nurse her baby, the young woman couldn’t get her newborn to latch onto her breast.

• SB 22 (Migden, 2007)– Training for hospitals in lowest quartile of

breastfeeding rates– Model Hospital Policy Toolkit

• SB 502 (Pavley/deLeon, 2011)– Required hospital infant feeding policy to use Baby

Friendly guidelinesCalifornia Lawshttp://www.calwic.org/storage/CA_Breastfeeding_Laws.pdf

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Where to find the data & reports?

Report, State and County Facts– http://www.calwic.org/focus-areas/breastfeeding/hospital-rates-a-

reports

Hospital Breastfeeding Data

– http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx

– http://www.cdph.ca.gov/data/statistics/Pages/InHospitalBreastfeedingInitiationData.aspx

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Credit & ContactsFor data and slides, thanks to:Dr.Jane Heinig & Jennifer Banuelos, UC Davis Human Lactation CenterDaisy Silverio & Kari Malone, California State WICPublic Health Foundation Enterprises WIC

Karen FarleyCA WIC Associationkfarley@calwic.org 530-750-2280www.calwic.org

Dr. Jane HeinigUniversity of California, Davismjheinig@ucdavis.edu, 530-752-8681http://lactation.ucdavis.edu/

Robbie Gonzalez-DowCalifornia Breastfeeding Coalitionrobbie@californiabreastfeeding.org 831-917-8939www.californiabreastfeeding.org

Report funded by the California WIC Association through Kaiser Permanente’s Healthy Eating Active Living Program.

Photography Credits: William Mercer McLeod & Dina Marie Photography

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